Mental health care thin at Wisconsin county jails

An inmate in the La Crosse County men's jail, in 2006, has little to do but rest in his cell in a jail-issued uniform. Even the La Crosse County Jail, which an inspector described as 'a leader and model for other jails throughout the state and nation,' wasn't properly documenting actions relating to potentially suicidal inmates. (Peter Thomson/La Crosse Tribune)

For more than a decade, Milwaukee County's jail system has been under the scrutiny of a court-appointed medical monitor for its failure to provide adequate health care, including for inmates with mental illness.

In August, the monitor found mental health care in the county's two jails was still in shambles. Among the problems: Vacancies in top medical positions left jailers to make medical decisions, such as when an inmate should be removed from suicide watch. A man who had threatened to kill himself stopped eating and drinking for four days and was never taken to a hospital. He died in his cell.

Mental health advocates and correctional officials agree that Wisconsin's 72 county-run jails are strapped for resources and not prepared to deal with the large numbers of inmates with mental illness they house. The state Department of Corrections (DOC) is charged with oversight of jails, but the agency's inspectors are not physicians and, the agency said, not responsible for assessing the quality of health care.

The DOC inspection checklist includes whether the facilities keep adequate records, have the correct staff and keep medications secure. In Milwaukee County, for example, the two jails' most recent DOC inspections last December give no hint of the problems identified by Dr. Ronald Shansky, the court-appointed physician.

Again and again, inspector Gregory Bucholtz marked an X for "meets approval" for each health care standard, concluding that at Milwaukee County Correctional Facility-South, "Health care services at the facility continue to be good ... Mental health services also remain good."

Shansky's take, in an inspection days before that DOC visit, was radically different. He found systemic problems in several areas, including record keeping, delayed access to medical services and medications, and "severely mentally ill patients being inappropriately placed in disciplinary cells."

Just five counties' jails - Dane, Fond du Lac, Walworth, Washington and Waukesha - are accredited by the National Commission on Correctional Health Care, which uses health care professionals to assess the quality of care at facilities.

For more than a decade, Milwaukee County's jail system has been under the scrutiny of a court-appointed medical monitor for its failure to provide adequate health care, including for inmates with mental illness.

In August, the monitor found mental health care in the county's two jails was still in shambles. Among the problems: Vacancies in top medical positions left jailers to make medical decisions, such as when an inmate should be removed from suicide watch. A man who had threatened to kill himself stopped eating and drinking for four days and was never taken to a hospital. He died in his cell.

Mental health advocates and correctional officials agree that Wisconsin's 72 county-run jails are strapped for resources and not prepared to deal with the large numbers of inmates with mental illness they house. The state Department of Corrections (DOC) is charged with oversight of jails, but the agency's inspectors are not physicians and, the agency said, not responsible for assessing the quality of health care.

The DOC inspection checklist includes whether the facilities keep adequate records, have the correct staff and keep medications secure. In Milwaukee County, for example, the two jails' most recent DOC inspections last December give no hint of the problems identified by Dr. Ronald Shansky, the court-appointed physician.

Again and again, inspector Gregory Bucholtz marked an X for "meets approval" for each health care standard, concluding that at Milwaukee County Correctional Facility-South, "Health care services at the facility continue to be good ... Mental health services also remain good."

Shansky's take, in an inspection days before that DOC visit, was radically different. He found systemic problems in several areas, including record keeping, delayed access to medical services and medications, and "severely mentally ill patients being inappropriately placed in disciplinary cells."

Just five counties' jails - Dane, Fond du Lac, Walworth, Washington and Waukesha - are accredited by the National Commission on Correctional Health Care, which uses health care professionals to assess the quality of care at facilities.

Seeking information State Rep. Garey Bies, R-Sister Bay, who chairs the Assembly Committee on Criminal Justice and Corrections, said he plans to ask the DOC to present information to his committee on how well jails are caring for their inmates.

As a former chief deputy sheriff, Bies used to oversee the Door County Jail. He said he is particularly interested in ensuring inmates are screened for mental health problems, which he said is crucial to providing proper care, helping them transition back into the community and avoiding crises that could arise while they're incarcerated.

"Do that (screening) up front, and it really cuts down on issues in the long run," Bies said.

In a 2009 DOC survey, less than half of the county jails that responded had a registered nurse or mental health professional doing the initial health screening of inmates; correctional officers did it in most jails.

The DOC makes inspections of county jails annually, and investigates after suicides and other incidents.

"We mitigate risk by providing technical assistance and training, based on best correctional practice," said Kristi Dietz, director of the DOC's Office of Detention Facilities. The agency provides verbal or written feedback after inspections, but it doesn't punish jails with sanctions.

Lawsuits are frequently cited as an incentive for jails to improve.

But "you can't count on lawsuits to expose these types of problems," said Larry Dupuis, legal director of the American Civil Liberties Union of Wisconsin, which sued Milwaukee County over its lack of jail health care services.

Ron Honberg, policy and legal director for the nonprofit National Alliance on Mental Illness (NAMI), said county jails nationwide have a "long, long way to go" in providing adequate mental health care.

More need, less attention Communities are falling short at helping people with mental illnesses, "and as a result the jails and prisons, unfortunately, have been taking on more and more of that population," Dietz said.

A national study estimated that one in three female inmates and nearly one in six males suffers from mental illness - far higher than the general population estimate of 6 percent. Even after a substantial drop from 1990 to 2010, the national jail suicide rate is still three times greater than in the general population.

Jail officials and advocates statewide have been seeing more inmates with mental illness in recent years, although no specific estimates are available.

The problems in jails often are overshadowed by those in prisons. But mental health needs actually may be greater at these facilities, where inmates face uncertain fates, more stress and fewer services.

And jails aren't only for short-term detention - some inmates end up spending years there if they have consecutive sentences or their trials are delayed. Walworth County Jail Superintendent Howard Sawyers said his county almost always has inmates who have passed the one-year mark, some staying two or three years.

Since 2003, 52 Wisconsin county jail inmates have taken their own lives. According to a Wisconsin Center for Investigative Journalism calculation, Wisconsin's jail suicide rate in recent years was 40 per 100,000 inmates, slightly higher than the 2007 national rate of 36.

According to Dean Meyer, executive director of the Badger State Sheriff's Association, state-run prisons are "much better equipped" to provide health care.

"A prison has their own dentist, their own doctors and their own nurses. And for the majority of county jails, they contract that service out, and the providers only come when needed," Meyer said.

Mental health care varies greatly from county to county, and it can be thin at many county jails.

Jails are required by a state law dating back to 1987 to provide the DOC with annual reports on mental health care services. Since 1989, the law has required the DOC to summarize and relay those findings to the Legislature. But the DOC acknowledges it has not regularly asked jails for the reports, and has not prepared summaries for the Legislature, the Center found.

Bies and a fellow lawmaker, Sen. Kathleen Vinehout, D-Alma, said they are concerned about mental health care in jails, but lack the information to tackle the issue.

Vinehout, a member of the Senate Committee on Education and Corrections, said she couldn't get information she wanted from the DOC about the types of inmates and the care they need. She thinks the agency should strengthen its oversight of local jails to help inmates - and the general public.

"We want to be able to understand what's happening and do what we can to lower the cost and make Wisconsin a safer place," Vinehout said.